Intravenous fluid therapy: Difference between revisions
 
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==Acute Repletion (Bolus)==
==Acute Repletion (Bolus)==
===Adult===
*Typically 20-mL/kg aliquots of isotonic (e.g., NS or LR) fluid
 
===Pediatric===
''See [[critical care quick reference]] for drug doses by weight.''


==Maintenance Fluids==
==Maintenance Fluids==
===Adult===
*Insensible losses = 300-400 cc/m2/d
*Insensible losses = 300-400 cc/m2/d
*Adult Standard: D5 0.45%NS at 75-125 mL/hr + 20meq/L of KCl
*Adult Standard: D5 0.45%NS at 75-125 mL/hr + 20meq/L of KCl
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**Hourly rate  daily volume/24 hr
**Hourly rate  daily volume/24 hr
***(or correct 1/2 of deficit in first 8 hr, remainder in next 16)
***(or correct 1/2 of deficit in first 8 hr, remainder in next 16)
*Calculation 1
**100 cc/kg/d (4cc/kg/h) 1st 10 kg
**50 cc/kg/d  (2cc/kg/h) 2nd 10 kg
**20 cc/kg/d  (1cc/kg/h) each kg > 20
*Calculation 2
**1500 cc/m2/d (bsa (m2) = sqr rt [wt (kg) x ht (cm)]/3600
===Pediatric===
*Maintenance fluid default: D5-LR + 20meq/L of KCl or other isotonic solution
**Isotonic fluids are now preferred (2019 AAP update)<ref> Leonard G. Feld, Daniel R. Neuspiel, Byron A. Foster, Michael G. Leu, Matthew D. Garber, Kelly Austin, Rajit K. Basu, Edward E. Conway, James J. Fehr, Clare Hawkins, Ron L. Kaplan, Echo V. Rowe, Muhammad Waseem, Michael L. Moritz, SUBCOMMITTEE ON FLUID AND ELECTROLYTE THERAPY; Clinical Practice Guideline: Maintenance Intravenous Fluids in Children. Pediatrics December 2018; 142 (6): e20183083. 10.1542/peds.2018-3083 </ref>
===4-2-1 Rule===
====Rule====
*mL/hr =
**(4 x first 10kg) '''+'''
**(2 x second 10kg) '''+'''
**(1 x every 1kg after)
*Example: For a 34 kg infant, you should run the IVF at 74 mL/hr. Often people choose to round to multiples of 5.
===Alternative Method===
{| class="wikitable"
|-
|
'''Weight (kg)'''
| '''Fluid Rate '''<br/>
| '''Example '''<br/>
|-
| <10<br/>
| 4 mL/kg per hour<br/>
|
8 kg infant:
4mL/kg per hour x 8 kg
|-
| 10 to 20<br/>
|
40 mL/h +
2 mL/kg per hour per each add kg
|
15 kg child:
40 mL/h +
2 mL/kg per hour x 5 kg
|-
| >20<br/>
|
60 mL/h +
1 mL/kg per hour per each add kg
|
30 kg child:
60 mL/h +
1 mL/kg per hour x 10 kg
|}
====Quick Reference (Peds)====
{| class="wikitable"
|-
| '''Age'''
| '''WT (kg)'''
| '''IVF (mL/hr)'''
|-
| Premature
| 2
| 8
|-
| Newborn
| 3.5
| 14
|-
| 2mo
| 5
| 20
|-
| 4mo
| 6.5
| 26
|-
| 6mo
| 8
| 32
|-
| 8mo
| 9
| 36
|-
| 12mo
| 10
| 40
|-
| 15mo
| 11
| 42
|-
| 2yr
| 13
| 46
|-
| 3yr
| 15
| 50
|-
| 5yr
| 19
| 58
|}


==Electrolytes==
==Electrolytes==
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*(Maintenance + deficit)/daily volume = concentration of electrolyte in fluid to be given
*(Maintenance + deficit)/daily volume = concentration of electrolyte in fluid to be given
*4mL/kg of H2O lost, ups Na by 1meq
*4mL/kg of H2O lost, ups Na by 1meq
*Normal saline (NS) = 154 mEq Na/L, 1/2 NS = 77 mEq/L, 1/4NS = 38 mEq/L


==See Also==
==See Also==
*[[Critical care quick reference]]
*[[Critical care quick reference]]
*[[Vascular access]]
*[[Vascular access]]
*[[Electrolyte abnormalities]]


==External Links==
==External Links==
* [https://www.google.com/search?q=mdcalc+maintenance+fluids&rlz=1C1VDKB_enUS990US990&oq=mdcalc+main&aqs=chrome.0.0i512j69i57j0i390.3894j0j7&sourceid=chrome&ie=UTF-8/ MDCalc maintenance fluids]
* [https://www.mdcalc.com/calc/72/maintenance-fluids-calculations MDCalc maintenance fluids]
*http://www.aliem.com/paucis-verbis-composition-of-intravenous-fluids/
*http://www.aliem.com/paucis-verbis-composition-of-intravenous-fluids/


Latest revision as of 19:51, 12 June 2024

This page is for adult patients. For pediatric patients, see: Intravenous fluid therapy (peds) or critical care quick reference for bolus doses by weight.

Background

Composition of Different Intravenous Fluids

Fluid [1] Osm Na Cl Glucose(g/L) pH Buffer K Ca Mg
Plasma 289 140 103 7.4 HCO3 22-32 4 5 2
Normal Saline (NS) 308 154 154 0 5.0 0 0 0 0
D5NS 560 154 154 50 0 0 0
Lactated Ringers 273 130 109 0 6.5 Lactate 28 4 3 0
Plasmalyte 295 140 98 0 5.0 Gluconate 23/Acetate 27 5 0 3
D5 1/2NS 406 77 77 500 4.5 0 0 0 0
D5W 252 0 0 50
5% Albumin 309 130-160 130-160 6.4-7.4 <1

Total Body Water

  • Total Body Water (TBW) = 0.6 x weight (kg)
    • Of which, 2/3 is intracellular and 1/3 extracellular
      • 1/4 of extracellular is vascular

Acute Repletion (Bolus)

  • Typically 20-mL/kg aliquots of isotonic (e.g., NS or LR) fluid

Maintenance Fluids

  • Insensible losses = 300-400 cc/m2/d
  • Adult Standard: D5 0.45%NS at 75-125 mL/hr + 20meq/L of KCl
  • Deficit: % dehydration x baseline weight
  • Daily volume needed = maintenance + deficit - fluid already given (i.e. boluses)
    • Hourly rate daily volume/24 hr
      • (or correct 1/2 of deficit in first 8 hr, remainder in next 16)

Electrolytes

  • Maintenance Na = 3 mEq/kg/d; K = 2 mEq/kg/d
  • Deficit = [desired - measured mEq/L] x fD x wt (kg)
  • fD (distribution factor) Na = 0.6, K = 0.6, Cl = 0.2-0.3, HCO3 = 0.5
  • (Maintenance + deficit)/daily volume = concentration of electrolyte in fluid to be given
  • 4mL/kg of H2O lost, ups Na by 1meq

See Also

External Links

References

  1. ↑ Paucis Verbis: Composition of intravenous fluids. http://www.aliem.com/paucis-verbis-composition-of-intravenous-fluids/ Published January 3, 2013. Accessed August 29, 2015
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